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Physiologie de la continence fécale et de la defecation

Physiologie de la continence fécale et de la defecation

Abstract

A53 Expos6 didactique Physiologie de la continence fkale et de la defkcation Michel BOUVIER Laboratoire de Neurobiologie (E2), CNRS 31 chemin Joseph Aiguier B.P. 71. F-13402 Marseille INTRODUCTION La continence fkcale et la dkfkcation sont assurkes par un ensemble moteur form6 de muscles lisses a commande involontaire et de muscles striks it commande volontaire. Cet ensemble, qui comprend essentiellement le rectum, les sphinctersde l’anus et les muscles du plancher pelvien, est soumis A un contrBle nervew complexe assurant des relations entre les systbmes nerveux somatique et vegktatif. Chez le nouveau-nk, la dkfkation est indkpendante de la volonte. Chez l’adulte, le respect des normes socio-culturelles impose l’apprentissage de la continence qui s’effectue grPce a des processus de dktection, de discrimination, de retention et, finalement, d’expulsion des sous-produits de la digestion. L’accomplissement de ces fonctions suppose donc une convergence des informations sensorielles issues des visckres, des diffkrents territoires somatiques et de l’environnement. La diversitk de ces informations, la nkessitk d’une griode de maturation et les contraintes de la vie en sociktd expliquent probablement la frkquence des dysfonctionnements conskcutifs des troubles psychiques. Les problkmes posks par les patients souffrant d’incontinence ont conduit les cliniciens a s’intkresser trks tBt aux mkanismes des
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